Red Alert

The EMS Manager

 

 
 
 

David S. Becker | | Wednesday, November 21, 2007


Back in the mid- to late- 1960 s, the television show "Star Trek" portrayed the futuristic lives of starship crew on a mission to explore for new life forms. On almost every show the crew, while cruising in the solar system, faced some sort of new danger. Often, the ship s sensors picked up something abnormal that could affect the welfare of the ship, and a crewmember would notify the captain of the danger. The captain would then announce a Red Alert -- which meant crews should prepare to take immediate action to meet the danger.

So as the captain of your ship (organization), you need to be warned to take action and get actively involved concerning several dangers that face EMS -- and specifically field operations -- now and in the immediate future. My hope is that you can call for a Red Alert in your own organization if needed. I also hope EMS operations across your region, state and nation will help protect the operations aspect of your service delivery. Unfortunately, I hope you won t be surprised when other forces try to implement changes without your input.

Are you aware the American College of Physicians (ACEP) and the National Association of EMS Physicians (NAEMSP) recently developed a revision of a standardized list of equipment for ambulances? (as reviewed in JEMS.com author Dr. Keith Wesley s Oct. 23 article, The New National Standard for Equipment on Ambulances .) The list updates the equipment and supplies that ACEP and NAEMSP feel should be carried on ambulances.

I have to ask the question. Why aren t the people who actually operate and manage EMS services developing recommendations like these? They (You) are the ones working in the field and delivering prehospital care on a daily basis. Who should the real experts be at determining what equipment and supplies are needed for pre-hospital emergency medical care?

OK, I m not looking to pick a fight with the physicians. What I am trying to do is motivate EMS leaders to take leadership roles -- get involved at local, state and national levels and participate in helping EMS grow. Yes, EMS is still a child compared to other medical professions, but it s time for the upcoming leaders in EMS to become actively involved in making the delivery of emergency medical services better. That means stepping up to the plate and helping set the standards and guidelines for ambulance operations.

Every decade seems to develop around certain buzzwords, and today s EMS buzz word is evidence-based practice. We ve had 30 years of providing prehospital medicine based on none-to-little scientific proof. Now medical directors, state EMS officials, educators and researchers are slowly shifting the emphasis from a delivery model that was put in place without any evidence of benefit to prehospital care established on examples of care that provides the best benefit to patient outcomes. Again, this movement isn t being championed by the leaders who operate EMS services. Hello. Red Alert!

Managers and leaders in EMS should be looking at what services benefits their communities and be at the forefront of making sure those service are delivered.

Another area for a Red Alert is basing your service performance on standards of a high-performance EMS system that are established by national newspapers. Or by being sucked into believing that the only true measure of an EMS system is the measure of your cardiac arrest survival rates. Why would anyone base their performance, or success, on 1% or less of their call volume? This is like having 100 students in your class and only one pass the class. Is your success based on the one student or on the group? You be the judge. Don t get me wrong I believe in benchmarks and standards. I just don t believe that single criteria should be the only measure of a successful EMS system.

Field intubation is another area being closely monitored and researched by many different groups in medicine. When things go bad with a field intubation, there are mortal consequences. EMS leaders should be the main group looking into the quality and effectiveness of the performances of their field personnel and conducting relevant field research.

My main fear is that someday a dozen research studies will highlight the problems with intubation and the negative outcomes, and that the field personnel will be shaking their heads wondering how that procedure got taken away from them. EMS leaders need to be on alert for those studies designed to prove negative outcomes verses looking at the whole sum of potential outcomes.

My last Red Alert is for when medical device companies partner with national EMS groups to promote activities they feel should occur in the field. Especially when their focus is not on operations, I feel there might be a conflict of interest that is being driven by the sale of certain medical devices that as EMS leaders you need to watch out for.

So while you aren t exploring the final frontier in the 23 century, you are busy shaping EMS in your community. It s important to sometimes take a big-picture view of your organization and EMS (say from 30,000 feet).

Like the captain of a starship, EMS leaders have to be alert, active and watch out for those things that will impact your future. Knowing what to look out for could help prevent problems before they get out of hand. Please make sure to fine tune your sensors and be on the lookout for issues and activities, especially on a national level, that will impact how you deliver EMS in your community.


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